Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

I am currently 33 weeks pregnant, trying for a VBAC after an
unnecessary first c-sec (“failure to wait”) and
currently I have gestational diabetes.

Up until this week, my blood sugars have been controlled through
diet alone, but now it looks as though my fasting numbers are too
high (above 100) and my OB wants to put me on insulin. I would be
fine with this except that she claims that once I am on insulin,
the baby must be delivered by 39 weeks. I can’t understand
why it would be necessary for an induction or RCS at 39 weeks if my
blood glucose is controlled. I am having trouble finding
evidence-based guidelines that are a high level of evidence and
specific to woman with gestational diabetes that is
well-controlled.

Can you give me any insight or point me to some
literature?As long as I have no other risk
factors and my blood glucose is controlled, would I be
irresponsible to refuse an induction at 39 weeks or even 40 or 41
(assuming NSTs shows everything is fine with the baby)? I'm
wondering if maybe insulin increases the rate at which the placenta
degrades?

Between what is on the thread itself and links out within the
posts, I think
this thread on gestational diabetes will cover most of what I
have to say on GD and induction .

Having a prior c/sec intensifies the reasons not to have an
elective delivery at 39 wks, or, frankly, at any time. Inducing
labor with a uterine scar is a "batting 0 for 2" proposition. It
poses both increased risk of scar rupture and
reduced probability of vaginal birth, especially with an unripe
cervix and regardless of use of agents or procedures to ready an
unripe cervix for labor. Scheduling elective cesarean surgery
is an even worse idea. Every subsequent surgery exposes you and
your baby not only to the risks of the current
surgery but increases the risk of life-threatening
complications of placental attachment in any future pregnancies.
Even if you do not plan any more children, that is something
to consider because many a woman has changed her mind or decided to
carry through with an unplanned pregnancy.

I do not know whether requiring insulin changes the equation,
although it seems logical, as I wrote in the other GD thread, that
if your blood sugars are normal, then you would be at no greater
risk. If there is increased risk--and I would want my care
provider to give me solid evidence that there was--you will have to
weigh it against the risks of planned delivery. If
you decide on induction, you can minimize your risk of
undesirable outcome by not inducing until the cervix is ripe.

I hope this helps.

-- Henci

All Times America/New_York

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